Seroprevalence of Antibodies against Porcine Teschovirus 1 in Lithuania

The objective of the present work was to study the serological status and epidemiological situation of porcine teschovirus 1 (PTV-1) on swine farms in different Lithuanian regions by using virus neutralization test and virus isolation. Clinical, epidemiological, serological and virological examinations were performed for the diagnosis of Teschen disease (porcine enterovirus encephalomyelitis, TE). Swine blood serum samples (n = 1680) were collected on 28 farms (60 samples per farm) of 8 regions in 2003. For virus isolation 29 samples of pathological material were taken from the brains of pigs (2 - 4 months of age) that died suddenly on seven swine farms in five regions. Epidemiological and clinical examination revealed no signs of porcine enterovirus encephalomyelitis on 32 Lithuanian swine farms. PTV-1 was not isolated and identified in the PK-15 cell culture. Antibodies against PTV-1, detected by using VNT, were found on all investigated farms and in all age groups. Negative serum (2.3%, 39 from 1680) samples were found in 15.5% (16 from 103) of 2-4-month-old pigs and in 4.7% (23 from 494) of 4-6-month-old ones. The positive serological and negative epidemiological, clinical and virological results suggest that less virulent or avirulent PTV-1 strains were spread on Lithuanian swine farms

Direct access CT for suspicion of brain tumour: an analysis of referral pathways in a population-based patient group

This is the final version. Available on open access from BMC via the DOI in this recordAvailability of data and materials: The dataset used during this study are available from the corresponding author in reasonable request.Background: Brain tumour patients see their primary care doctor on average three or more times before diagnosis, so there may be an opportunity to identify 'at risk' patients earlier. Suspecting a brain tumour diagnosis is difficult because brain tumour-related symptoms are typically non-specific. Methods: We explored the predictive value of referral guidelines (Kernick and NICE 2005) for brain imaging where a tumour is suspected, in a population-based patient group referred for direct access CT of the head. A consensus panel reviewed whether non-tumour findings were clinically important or whether further investigation was necessary. Results: Over a 5-year period, 3257 head scans were performed; 318 scans were excluded according to pre-specified criteria. 53 patients (1.8%) were reported to have intracranial tumours, of which 42 were significant (diagnostic yield of 1.43%). There were no false negative CT scans for tumour. With symptom-based referral guidelines primary care doctors can identify patients with a 3% positive predictive value (PPV). 559 patients had non-tumour findings, 31% of which were deemed clinically significant. In 34% of these 559 patients, referral for further imaging and/or specialist assessment from primary care was still thought warranted. Conclusion: Existing referral guidelines are insufficient to stratify patients adequately based on their symptoms, according to the likelihood that a tumour will be found on brain imaging. Identification of non-tumour findings may be significant for patients and earlier specialist input into interpretation of these images may be beneficial. Improving guidelines to better identify patients at risk of a brain tumour should be a priority, to improve speed of diagnosis, and reduce unnecessary imaging and costs. Future guidelines may incorporate groups of symptoms, clinical signs and tests to improve the predictive value.Brain Tumour Charit

Eliminating Rabies in Estonia

The compulsory vaccination of pets, the recommended vaccination of farm animals in grazing areas and the extermination of stray animals did not succeed in eliminating rabies in Estonia because the virus was maintained in two main wildlife reservoirs, foxes and raccoon dogs. These two species became a priority target therefore in order to control rabies. Supported by the European Community, successive oral vaccination (OV) campaigns were conducted twice a year using Rabigen® SAG2 baits, beginning in autumn 2005 in North Estonia. They were then extended to the whole territory from spring 2006. Following the vaccination campaigns, the incidence of rabies cases dramatically decreased, with 266 cases in 2005, 114 in 2006, four in 2007 and three in 2008. Since March 2008, no rabies cases have been detected in Estonia other than three cases reported in summer 2009 and one case in January 2011, all in areas close to the South-Eastern border with Russia. The bait uptake was satisfactory, with tetracycline positivity rates ranging from 85% to 93% in foxes and from 82% to 88% in raccoon dogs. Immunisation rates evaluated by ELISA ranged from 34% to 55% in foxes and from 38% to 55% in raccoon dogs. The rabies situation in Estonia was compared to that of the other two Baltic States, Latvia and Lithuania. Despite regular OV campaigns conducted throughout their territory since 2006, and an improvement in the epidemiological situation, rabies has still not been eradicated in these countries. An analysis of the number of baits distributed and the funding allocated by the European Commission showed that the strategy for rabies control is more cost-effective in Estonia than in Latvia and Lithuania

Seroprevalence of Antibodies against Porcine Teschovirus 1 in Lithuania

The objective of the present work was to study the serological status and epidemiological situation of porcine teschovirus 1 (PTV-1) on swine farms in different Lithuanian regions by using virus neutralization test and virus isolation. Clinical, epidemiological, serological and virological examinations were performed for the diagnosis of Teschen disease (porcine enterovirus encephalomyelitis, TE). Swine blood serum samples (n = 1680) were collected on 28 farms (60 samples per farm) of 8 regions in 2003. For virus isolation 29 samples of pathological material were taken from the brains of pigs (2 -4 months of age) that died suddenly on seven swine farms in five regions. Epidemiological and clinical examination revealed no signs of porcine enterovirus encephalomyelitis on 32 Lithuanian swine farms. PTV-1 was not isolated and identified in the PK-15 cell culture. Antibodies against PTV-1, detected by using VNT, were found on all investigated farms and in all age groups. Negative serum (2.3%, 39 from 1680) samples were found in 15.5% (16 from 103) of 2-4-month-old pigs and in 4.7% (23 from 494) of 4-6-month-old ones. The positive serological and negative epidemiological, clinical and virological results suggest that less virulent or avirulent PTV-1 strains were spread on Lithuanian swine farms. Teschen disease, porcine enterovirus encephalomyeliti

Phylogenetic characterization of Canine Parvovirus VP2 partial sequences from symptomatic dogs samples

The aim of the present study was to detect canine parvovirus (CPV) from faecal samples of clinically ill domestic dogs by polymerase chain reaction (PCR) followed by VP2 gene partial sequencing and molecular characterization of circulating strains in Lithuania. Eleven clinically and antigen-tested positive dog faecal samples, collected during the period of 2014-2015, were investigated by using PCR. The phylogenetic investigations indicated that the Lithuanian CPV VP2 partial sequences (3025-3706 cds) were closely related and showed 99.0-99.9% identity. All Lithuanian sequences were associated with one phylogroup, but grouped in different clusters. Ten of investigated Lithuanian CPV VP2 sequences were closely associated with CPV 2a antigenic variant (99.4% nt identity). Five CPV VP2 sequences from Lithuania were related to CPV-2a, but were rather divergent (6.8 nt differences). Only one CPV VP2 sequence from Lithuania was associated (99.3% nt identity) with CPV-2b VP2 sequences from France, Italy, USA and Korea. The four of eleven investigated Lithuanian dogs with CPV infection symptoms were vaccinated with CPV-2 vaccine, but their VP2 sequences were phylogenetically distantly associated with CPV vaccine strains VP2 sequences (11.5-15.8 nt differences). Ten Lithuanian CPV VP2 sequences had monophyletic relations among the close geographically associated samples, but five of them were rather divergent (1.0% less sequence similarity). The one Lithuanian CPV VP2 sequence was closely related with CPV-2b antigenic variant. All the Lithuanian CPV VP2 partial sequences were conservative and phylogenetically low associated with most commonly used CPV vaccine strains

Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation

Background Cognitive deficits are common in people who have received cranial irradiation and have a serious impact on daily functioning and quality of life. The benefit of pharmacological and non‐pharmacological treatment of cognitive deficits in this population is unclear. This is an updated version of the original Cochrane Review published in Issue 12, 2014. Objectives To assess the effectiveness of interventions for preventing or ameliorating cognitive deficits in adults treated with cranial irradiation. Search methods For this review update we searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Embase via Ovid, and PsycInfo via Ovid to 12 September 2022. Selection criteria We included randomised controlled (RCTs) trials that evaluated pharmacological or non‐pharmacological interventions in cranial irradiated adults, with objective cognitive functioning as a primary or secondary outcome measure. Data collection and analysis Two review authors (MK, JD) independently extracted data from selected studies and carried out a risk of bias assessment. Cognitive function, fatigue and mood outcomes were reported. No data were pooled. Main results Eight studies met the inclusion criteria and were included in this updated review. Six were from the original version of the review, and two more were added when the search was updated. Nineteen further studies were assessed as part of this update but did not fulfil the inclusion criteria. Of the eight included studies, four studies investigated “prevention” of cognitive problems (during radiotherapy and follow‐up) and four studies investigated “amelioration” (interventions to treat cognitive impairment as a late complication of radiotherapy). There were five pharmacological studies (two studies on prevention and three in amelioration) and three non‐pharmacological studies (two on prevention and one in amelioration). Due to differences between studies in the interventions being evaluated, a meta‐analysis was not possible. Studies in early radiotherapy treatment phase (five studies) Pharmacological studies in the “early radiotherapy treatment phase” were designed to prevent or ameliorate cognitive deficits and included drugs used in dementia (memantine) and fatigue (d‐threo‐methylphenidate hydrochloride). Non‐pharmacological studies in the “early radiotherapy treatment phase” included a ketogenic diet and a two‐week cognitive rehabilitation and problem‐solving programme. In the memantine study, the primary cognitive outcome of memory at six months did not reach significance, but there was significant improvement in overall cognitive function compared to placebo, with similar adverse events across groups. The d‐threo‐methylphenidate hydrochloride study found no statistically significant difference between arms, with few adverse events. The study of a calorie‐restricted ketogenic diet found no effect, although a lower than expected calorie intake in the control group complicates interpretation of the results. The study investigating the utility of a rehabilitation program did not carry out a statistical comparison of cognitive performance between groups. Studies in delayed radiation or late effect phase (four studies) The “amelioration” pharmacological studies to treat cognitive complications of radiotherapy included drugs used in dementia (donepezil) or psychostimulants (methylphenidate and modafinil). Non‐pharmacological measures included cognitive rehabilitation and problem solving (Goal Management Training). These studies included patients with cognitive problems at entry who had “stable” brain cancer. The donepezil study did not find an improvement in the primary cognitive outcome of overall cognitive performance, but did find improvement in an individual test of memory, compared to placebo; adverse events were not reported. A study comparing methylphenidate with modafinil found improvements in cognitive function in both the methylphenidate and modafinil arms; few adverse events were reported. Another study comparing two different doses of modafinil combined treatment arms and found improvements across all cognitive tests, however, a number of adverse events were reported. Both studies were limited by a small sample size. The Goal Management Training study suggested a benefit of the intervention, a behavioural intervention that combined mindfulness and strategy training, on executive function and processing speed. There were a number of limitations across studies and few were without high risks of bias. Authors' conclusions In this update, limited additional evidence was found for the treatment or amelioration of cognitive deficits in adults treated with cranial irradiation. As concluded in the original review, there is supportive evidence that memantine may help prevent cognitive deficits for adults with brain metastases receiving cranial irradiation. There is supportive evidence that donepezil, methylphenidate and modafinil may have a role in treating cognitive deficits in adults with brain tumours who have been treated with cranial irradiation; patient withdrawal affected the statistical power of these studies. Further research that tries to minimise the withdrawal of consent, and subsequently reduce the requirement for imputation procedures, may offer a higher certainty of evidence. There is evidence from only a single small study to support non‐pharmacological interventions in the amelioration of cognitive deficits. Further research is required

Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation

Background Cognitive deficits are common in people who have received cranial irradiation and have a serious impact on daily functioning and quality of life. The benefit of pharmacological and non‐pharmacological treatment of cognitive deficits in this population is unclear. This is an updated version of the original Cochrane Review published in Issue 12, 2014. Objectives To assess the effectiveness of interventions for preventing or ameliorating cognitive deficits in adults treated with cranial irradiation. Search methods For this review update we searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Embase via Ovid, and PsycInfo via Ovid to 12 September 2022. Selection criteria We included randomised controlled (RCTs) trials that evaluated pharmacological or non‐pharmacological interventions in cranial irradiated adults, with objective cognitive functioning as a primary or secondary outcome measure. Data collection and analysis Two review authors (MK, JD) independently extracted data from selected studies and carried out a risk of bias assessment. Cognitive function, fatigue and mood outcomes were reported. No data were pooled. Main results Eight studies met the inclusion criteria and were included in this updated review. Six were from the original version of the review, and two more were added when the search was updated. Nineteen further studies were assessed as part of this update but did not fulfil the inclusion criteria. Of the eight included studies, four studies investigated “prevention” of cognitive problems (during radiotherapy and follow‐up) and four studies investigated “amelioration” (interventions to treat cognitive impairment as a late complication of radiotherapy). There were five pharmacological studies (two studies on prevention and three in amelioration) and three non‐pharmacological studies (two on prevention and one in amelioration). Due to differences between studies in the interventions being evaluated, a meta‐analysis was not possible. Studies in early radiotherapy treatment phase (five studies) Pharmacological studies in the “early radiotherapy treatment phase” were designed to prevent or ameliorate cognitive deficits and included drugs used in dementia (memantine) and fatigue (d‐threo‐methylphenidate hydrochloride). Non‐pharmacological studies in the “early radiotherapy treatment phase” included a ketogenic diet and a two‐week cognitive rehabilitation and problem‐solving programme. In the memantine study, the primary cognitive outcome of memory at six months did not reach significance, but there was significant improvement in overall cognitive function compared to placebo, with similar adverse events across groups. The d‐threo‐methylphenidate hydrochloride study found no statistically significant difference between arms, with few adverse events. The study of a calorie‐restricted ketogenic diet found no effect, although a lower than expected calorie intake in the control group complicates interpretation of the results. The study investigating the utility of a rehabilitation program did not carry out a statistical comparison of cognitive performance between groups. Studies in delayed radiation or late effect phase (four studies) The “amelioration” pharmacological studies to treat cognitive complications of radiotherapy included drugs used in dementia (donepezil) or psychostimulants (methylphenidate and modafinil). Non‐pharmacological measures included cognitive rehabilitation and problem solving (Goal Management Training). These studies included patients with cognitive problems at entry who had “stable” brain cancer. The donepezil study did not find an improvement in the primary cognitive outcome of overall cognitive performance, but did find improvement in an individual test of memory, compared to placebo; adverse events were not reported. A study comparing methylphenidate with modafinil found improvements in cognitive function in both the methylphenidate and modafinil arms; few adverse events were reported. Another study comparing two different doses of modafinil combined treatment arms and found improvements across all cognitive tests, however, a number of adverse events were reported. Both studies were limited by a small sample size. The Goal Management Training study suggested a benefit of the intervention, a behavioural intervention that combined mindfulness and strategy training, on executive function and processing speed. There were a number of limitations across studies and few were without high risks of bias. Authors' conclusions In this update, limited additional evidence was found for the treatment or amelioration of cognitive deficits in adults treated with cranial irradiation. As concluded in the original review, there is supportive evidence that memantine may help prevent cognitive deficits for adults with brain metastases receiving cranial irradiation. There is supportive evidence that donepezil, methylphenidate and modafinil may have a role in treating cognitive deficits in adults with brain tumours who have been treated with cranial irradiation; patient withdrawal affected the statistical power of these studies. Further research that tries to minimise the withdrawal of consent, and subsequently reduce the requirement for imputation procedures, may offer a higher certainty of evidence. There is evidence from only a single small study to support non‐pharmacological interventions in the amelioration of cognitive deficits. Further research is required